From Our 2012 Archives

Infant Dies in New E. Coli Outbreak

Ongoing Toxic E. Coli O145 Outbreak: 14 Cases in 6 States, Cause Unknown

By Daniel J. DeNoon
WebMD Health News

Reviewed by Louise Chang, MD

June 8, 2012 -- A New Orleans infant is dead and 13 others in six states have been sickened in an ongoing E. coli outbreak.

All of the known cases are caused by a strain of E. coli O145 with the same DNA signature.

The cause of the outbreak is unknown, although CDC and state health officials are working feverishly to identify what the victims had in common and to trace the outbreak to its source. It's not yet known whether this is a food-borne outbreak, CDC spokeswoman Lola Russell tells WebMD.

The 21-month-old New Orleans girl died on May 31. Two other known cases are in New Orleans. Reported cases are in Georgia (two in Cobb County and one each in Cherokee, Coweta, and Forsyth counties), Alabama (2), California (1), Florida (one in Leon County), Louisiana (4 ), and Tennessee (1).

The first reported illness in the outbreak was on April 15; the most recent illness onset was May 12. The outbreak is considered to be ongoing, as people infected with the outbreak strain may not yet have fallen ill. It usually takes two or three weeks for a case to be reported to the CDC.

A child in Massachusetts recently died of E. coli. However, that child was infected with an E. coli O157 strain not related to this outbreak.

Symptoms of Toxic E. Coli Infection

While many strains of E. coli are normal residents of a healthy gut, some strains cause disease. E. coli O145 is one of them. It's one of the E. coli strains that carry Shiga toxin. These strains are called Shiga toxin-producing E. coli (STEC), verocytotoxic E. coli (VTEC), or enterohemorrhagic E. coli (EHEC).

People infected with STEC usually fall ill three or four days later, although they may get sick as soon as one day or as many as 10 days after infection. Symptoms include severe stomach cramps, diarrhea (often bloody), and vomiting. Some patients get a fever, but it's usually less than 101 degrees Fahrenheit.

E. coli illness usually goes away in five to seven days. But 5% to 10% of people with STEC infections get a very severe, life-threatening complication called hemolytic uremic syndrome or HUS. Symptoms of HUS include decreased urination, fatigue, and loss of the pink color in the cheeks and lower eyelids. People with HUS need urgent care, as the complication can lead to kidney failure or death.

Although healthy people of any age can get E. coli infections and even HUS, very young children and the elderly are at highest risk.

A person infected with STEC may carry the bug for weeks or even months after symptoms go away.

Preventing E. coli Illness

STEC outbreaks generally begin in livestock. Although contaminated meat may carry the bugs, outbreaks often are caused by contaminated produce.

E. coli is spread by oral-fecal contact. People often unknowingly eat microscopic amounts of human or animal feces. Obvious sources of contact are eating contaminated food (such as undercooked contaminated meat or unpasteurized milk), contact with cattle, or changing diapers. Less obvious sources of contact include eating food prepared by people who did not properly wash their hands after using the toilet.

It's probably impossible to fully ensure that you never encounter STEC bacteria. But here's the CDC's advice on how to limit your risk:

  • Wash your hands thoroughly after using the bathroom or changing diapers and before preparing or eating food. Wash your hands after contact with animals or their environments (at farms, petting zoos, fairs, even your own backyard).
  • Cook meats thoroughly. Ground beef and meat that has been needle-tenderized should be cooked to a temperature of at least 160 degrees Fahrenheit. It's best to use a thermometer, as color is not a very reliable indicator of "doneness."
  • Avoid raw milk, unpasteurized dairy products, and unpasteurized juices (like fresh apple cider).
  • Avoid swallowing water when swimming or playing in lakes, ponds, streams, swimming pools, and backyard "kiddie" pools.
  • Prevent cross contamination in food preparation areas by thoroughly washing hands, counters, cutting boards, and utensils after they touch raw meat.

Most STEC outbreaks have been caused by an E. coli strain called O157. The FDA forbids sale of any beef trimmings with any amount of this bug. But there's been a growing realization that six other STEC strains have been causing U.S. outbreaks.

Ironically, the FDA this week began a zero-tolerance policy for six other STEC strains -- including E. coli O145.

The outbreak was first reported by ABC News.

SOURCES: CDC, email with Lola Russel, PIO. Georgia Department of Public Health, email with Suleima Salgado, deputy director, communications. ABC News. FDA news release, May 31, 2012.

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